Alterations in maternally perceived fetal movement and their association with late stillbirth

Findings from the Midland and North of England stillbirth case-control study

Alexander EP Heazell, Jayne Budd, Minglan Li, Robin Cronin, Billie Bradford, Lesley ME McCowan, Edwin A Mitchell, Tomasina Stacey, Bill Martin, Devender Roberts, John Md Thompson

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: To report perception of fetal movements in women who experienced a stillbirth compared with controls at a similar gestation with a live birth.
Design: Case–control study.
Setting: 41 maternity units in the UK.
Participants: Cases were women who had a late stillbirth ≥28 weeks gestation (n=291) and controls were women with an ongoing pregnancy at the time of the interview (n=733). Controls were frequency matched to cases by obstetric unit and gestational age.
Methods: Data were collected using an intervieweradministered questionnaire which included questions on maternal perception of fetal movement (frequency, strength, increased and decreased movements and hiccups) in the 2weeks before the interview/stillbirth. Five fetal movement patterns were identified incorporating the changes in strength and frequency in the last 2weeks by combining groups of similar pattern and risk. Multivariable analysis adjusted for known confounders.
Primary outcome measure: Association of maternally perceived fetal movements in relation to late stillbirth.
Results: In multivariable analyses, women who reported increased strength of movements in the last 2weeks had decreased risk of late stillbirth compared with those whose
movements were unchanged (adjusted OR (aOR) 0.18, 95%CI 0.13 to 0.26). Women with decreased frequency (without increase in strength) of fetal movements were
at increased risk (aOR 4.51, 95%CI 2.38 to 8.55). Daily perception of fetal hiccups was protective (aOR 0.31, 95%CI 0.17 to 0.56).
Conclusions: Increased strength of fetal movements and fetal hiccups is associated with decreased risk of stillbirth. Alterations in frequency of fetal movements are important in identifying pregnancies at increased risk of stillbirth, with the greatest risk in women noting a reduction in fetal activity. Clinical guidance should be updated to reflect that increase in strength and frequency of fetal movements is associated with the lowest risk of stillbirth, and that decreased fetal movements are associated with stillbirth.
Original languageUndefined
Article numbere020031
Pages (from-to)1-9
Number of pages9
JournalBMJ Open
Volume8
Issue number7
DOIs
Publication statusPublished - 6 Jul 2018
Externally publishedYes

Cite this

Heazell, Alexander EP ; Budd, Jayne ; Li, Minglan ; Cronin, Robin ; Bradford, Billie ; McCowan, Lesley ME ; Mitchell, Edwin A ; Stacey, Tomasina ; Martin, Bill ; Roberts, Devender ; Thompson, John Md. / Alterations in maternally perceived fetal movement and their association with late stillbirth : Findings from the Midland and North of England stillbirth case-control study. In: BMJ Open. 2018 ; Vol. 8, No. 7. pp. 1-9.
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title = "Alterations in maternally perceived fetal movement and their association with late stillbirth: Findings from the Midland and North of England stillbirth case-control study",
abstract = "Objective: To report perception of fetal movements in women who experienced a stillbirth compared with controls at a similar gestation with a live birth.Design: Case–control study.Setting: 41 maternity units in the UK.Participants: Cases were women who had a late stillbirth ≥28 weeks gestation (n=291) and controls were women with an ongoing pregnancy at the time of the interview (n=733). Controls were frequency matched to cases by obstetric unit and gestational age.Methods: Data were collected using an intervieweradministered questionnaire which included questions on maternal perception of fetal movement (frequency, strength, increased and decreased movements and hiccups) in the 2weeks before the interview/stillbirth. Five fetal movement patterns were identified incorporating the changes in strength and frequency in the last 2weeks by combining groups of similar pattern and risk. Multivariable analysis adjusted for known confounders.Primary outcome measure: Association of maternally perceived fetal movements in relation to late stillbirth.Results: In multivariable analyses, women who reported increased strength of movements in the last 2weeks had decreased risk of late stillbirth compared with those whosemovements were unchanged (adjusted OR (aOR) 0.18, 95{\%}CI 0.13 to 0.26). Women with decreased frequency (without increase in strength) of fetal movements wereat increased risk (aOR 4.51, 95{\%}CI 2.38 to 8.55). Daily perception of fetal hiccups was protective (aOR 0.31, 95{\%}CI 0.17 to 0.56).Conclusions: Increased strength of fetal movements and fetal hiccups is associated with decreased risk of stillbirth. Alterations in frequency of fetal movements are important in identifying pregnancies at increased risk of stillbirth, with the greatest risk in women noting a reduction in fetal activity. Clinical guidance should be updated to reflect that increase in strength and frequency of fetal movements is associated with the lowest risk of stillbirth, and that decreased fetal movements are associated with stillbirth.",
keywords = "Exaggerated fetal movement, Fetal movement, Maternal perception, Reduced fetal movement, Risk factor, Stillbirth",
author = "Heazell, {Alexander EP} and Jayne Budd and Minglan Li and Robin Cronin and Billie Bradford and McCowan, {Lesley ME} and Mitchell, {Edwin A} and Tomasina Stacey and Bill Martin and Devender Roberts and Thompson, {John Md}",
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Heazell, AEP, Budd, J, Li, M, Cronin, R, Bradford, B, McCowan, LME, Mitchell, EA, Stacey, T, Martin, B, Roberts, D & Thompson, JM 2018, 'Alterations in maternally perceived fetal movement and their association with late stillbirth: Findings from the Midland and North of England stillbirth case-control study', BMJ Open, vol. 8, no. 7, e020031, pp. 1-9. https://doi.org/10.1136/bmjopen-2017-020031

Alterations in maternally perceived fetal movement and their association with late stillbirth : Findings from the Midland and North of England stillbirth case-control study. / Heazell, Alexander EP; Budd, Jayne; Li, Minglan; Cronin, Robin; Bradford, Billie; McCowan, Lesley ME; Mitchell, Edwin A; Stacey, Tomasina; Martin, Bill; Roberts, Devender; Thompson, John Md.

In: BMJ Open, Vol. 8, No. 7, e020031, 06.07.2018, p. 1-9.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Alterations in maternally perceived fetal movement and their association with late stillbirth

T2 - Findings from the Midland and North of England stillbirth case-control study

AU - Heazell, Alexander EP

AU - Budd, Jayne

AU - Li, Minglan

AU - Cronin, Robin

AU - Bradford, Billie

AU - McCowan, Lesley ME

AU - Mitchell, Edwin A

AU - Stacey, Tomasina

AU - Martin, Bill

AU - Roberts, Devender

AU - Thompson, John Md

PY - 2018/7/6

Y1 - 2018/7/6

N2 - Objective: To report perception of fetal movements in women who experienced a stillbirth compared with controls at a similar gestation with a live birth.Design: Case–control study.Setting: 41 maternity units in the UK.Participants: Cases were women who had a late stillbirth ≥28 weeks gestation (n=291) and controls were women with an ongoing pregnancy at the time of the interview (n=733). Controls were frequency matched to cases by obstetric unit and gestational age.Methods: Data were collected using an intervieweradministered questionnaire which included questions on maternal perception of fetal movement (frequency, strength, increased and decreased movements and hiccups) in the 2weeks before the interview/stillbirth. Five fetal movement patterns were identified incorporating the changes in strength and frequency in the last 2weeks by combining groups of similar pattern and risk. Multivariable analysis adjusted for known confounders.Primary outcome measure: Association of maternally perceived fetal movements in relation to late stillbirth.Results: In multivariable analyses, women who reported increased strength of movements in the last 2weeks had decreased risk of late stillbirth compared with those whosemovements were unchanged (adjusted OR (aOR) 0.18, 95%CI 0.13 to 0.26). Women with decreased frequency (without increase in strength) of fetal movements wereat increased risk (aOR 4.51, 95%CI 2.38 to 8.55). Daily perception of fetal hiccups was protective (aOR 0.31, 95%CI 0.17 to 0.56).Conclusions: Increased strength of fetal movements and fetal hiccups is associated with decreased risk of stillbirth. Alterations in frequency of fetal movements are important in identifying pregnancies at increased risk of stillbirth, with the greatest risk in women noting a reduction in fetal activity. Clinical guidance should be updated to reflect that increase in strength and frequency of fetal movements is associated with the lowest risk of stillbirth, and that decreased fetal movements are associated with stillbirth.

AB - Objective: To report perception of fetal movements in women who experienced a stillbirth compared with controls at a similar gestation with a live birth.Design: Case–control study.Setting: 41 maternity units in the UK.Participants: Cases were women who had a late stillbirth ≥28 weeks gestation (n=291) and controls were women with an ongoing pregnancy at the time of the interview (n=733). Controls were frequency matched to cases by obstetric unit and gestational age.Methods: Data were collected using an intervieweradministered questionnaire which included questions on maternal perception of fetal movement (frequency, strength, increased and decreased movements and hiccups) in the 2weeks before the interview/stillbirth. Five fetal movement patterns were identified incorporating the changes in strength and frequency in the last 2weeks by combining groups of similar pattern and risk. Multivariable analysis adjusted for known confounders.Primary outcome measure: Association of maternally perceived fetal movements in relation to late stillbirth.Results: In multivariable analyses, women who reported increased strength of movements in the last 2weeks had decreased risk of late stillbirth compared with those whosemovements were unchanged (adjusted OR (aOR) 0.18, 95%CI 0.13 to 0.26). Women with decreased frequency (without increase in strength) of fetal movements wereat increased risk (aOR 4.51, 95%CI 2.38 to 8.55). Daily perception of fetal hiccups was protective (aOR 0.31, 95%CI 0.17 to 0.56).Conclusions: Increased strength of fetal movements and fetal hiccups is associated with decreased risk of stillbirth. Alterations in frequency of fetal movements are important in identifying pregnancies at increased risk of stillbirth, with the greatest risk in women noting a reduction in fetal activity. Clinical guidance should be updated to reflect that increase in strength and frequency of fetal movements is associated with the lowest risk of stillbirth, and that decreased fetal movements are associated with stillbirth.

KW - Exaggerated fetal movement

KW - Fetal movement

KW - Maternal perception

KW - Reduced fetal movement

KW - Risk factor

KW - Stillbirth

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